sleep deprivation

When I was a resident, we were talked to a lot on the dangers of fatigue and sleep disruption and how they related to medical errors.  It was around the time that resident hours were capped in the US.  In fact, we were told that tests show that our reaction times and ability to make decisions after a call shift were equivalent to those of someone with a blood alcohol level over the legal limit.  There was much discussion about whether or not we should drive home after a night on call, never mind whether we should treat patients!

During my medical training, I worked an average of 70 hours a week, day and night.  But I was never, ever, as fatigued as I was the first two months of parenthood.

When baby R was born, I had about a week of complete euphoria.  I was high on new-motherhood.  I cooked.  I cleaned.  I did loads and loads of laundry.  I spent 6 hours a day (minimum) breastfeeding.  I read three baby care books.  I was “nesting” after the birth.  Getting up every 2-3 hours to feed and change him and rock him back to sleep was novel and exciting.

And then….

Day 9 or 10 hit.

And it hit me hard.

For various reasons, my husband had to be out of town that second week.  I remember being up all night and a zombie during the day.  I had to call my mom so she could come over and hold R so that I could get a nap every afternoon.

Things got a little better…but only marginally.

I nearly put dish soap in the dishwasher.

I nearly put laundry detergent in the drier.

I stopped eating all food groups outside of muffins and brownies.  Yes, brownies are a food group.

Our dog stopped sleeping in our room because she couldn’t handle the ruckus.

At two weeks postpartum, on my way home from the family doctor’s office I committed at least two traffic violations that I can remember (I ran a stop sign and made an unsafe left hand turn.)

At my 6 week OB appointment I tried to park the car around a concrete post in the underground garage.  That was an expensive day.

The sleep deprivation really didn’t start to go away until after week 10 when R started sleeping through the night.  I can only imagine what things would be like otherwise.

I know that I’m still not right.  I have little patience and less emotional reserve than usual.  My sense of humour is sometimes absent.  My poor husband suffers.  I have a hard time falling asleep at night because of the adrenaline my body is producing in response to chronic fatigue.

I hear and read about 10 month olds that still get up two or three times a night.  Or, even worse, those that are up every 1-2 hours.  I can’t help but wonder, what is the toll of this parental sleep deprivation?

We all intuitively know that fatigue leaves us less able to enjoy activities, stresses our interpersonal relationships, obliterates sex drive, interferes with cognition, learning and problem solving…but did you know that poor sleep:

has been linked to obesity?

has been linked to depression?

has been linked to death?  In this meta-analysis, sleeping < 5-7 hours  a night was associated with a 12% increased risk of death.

has been linked to diabetes, high blood pressure, heart attack, and stroke?

can cause car accidents?  Drowsy driving in the US results in an estimated 100 000 crashes, 71 000 injuries and 1550 deaths a year?  Divide those numbers by 10 to get a rough estimate of the size of the problem in Canada.  I think driving is the most dangerous thing we do on a daily basis and I’m always shocked that we don’t pay more attention to doing it as safely as possible.  Think about it, you’re barrelling down the road at 40-60 km/hr in a few thousand pounds of metal and glass and plastic and the only reason you survive the trip is a combination of your car working properly, your ability to pay attention and react to changing conditions and that the other motorists respect the laws and painted lines enough not to smash into you.

After my garage post incident, I temporarily gave up driving until my son was sleeping through the night and I was less fatigued.  How do you know whether you are too fatigued to drive?  Although it appears that self-assessment of fatigue correlates with poorer scores on psychomotor-vigilance tasks, it is also true that most subjects in this study thought their driving skills, even when fatigued, were better than everyone elses.  We can’t all be better drivers than everyone else – half of us have to be worse!

All new parents are tired.  But being tired is a lot more than an inconvenience, it’s dangerous.  We need to monitor our fatigue and keep ourselves out of situations where we could be a danger to self and others.  We need to find ways to manage our children’s sleep so that the entire family wakes up rested every morning and not to settle for less than that.  And that means not giving each other a hard time for choosing methods that work for our families: co-sleeping or extinction or mystical sleep incantations (voodoo).

But please, don’t settle for getting up 10 times a night.  If a method isn’t working for you, you’re not married to it and you can certainly cheat on it….unless you’re getting up 10 times a night because of your spouse.

If that’s the case, I’ve got nothing for you.

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